1
|
Kong RM, Ibrahim M, Monessa D, Elali F, Jamil Z, Abdo T, Uribe JA, Suneja N. Osteochondral Lesions of the Talus: Evaluation of Risk Factors and Their Impact on Postoperative Outcomes. J Long Term Eff Med Implants 2024; 34:95-101. [PMID: 37938211 DOI: 10.1615/jlongtermeffmedimplants.2023046114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Osteochondral lesions of the talus (OLT), also known as talar osteochondritis dissecans, is minor fracture to the articular cartilage of the talas subchondral bone it is associated with. The literature regarding its impact on patient demographics on post-operative associations of OLT-related repairs is lacking. The American College of Surgeons National Surgical Improvement Program (NSQIP) database was retrospectively reviewed, collecting data on patients with an OLT procedure between the 2008 through 2016. Univariate analysis was utilized to compare patient demographics, potential risk factors, comorbidities, hospital, and operative variables. Finally, Logistic regressions were utilized, adjusting associations of its risk factors and respective associations in a postoperative manner. A total of 491 patients with an OLT were collected for analysis. Hypertension requiring medication was a risk factor for readmission (P = 0.039) and longer lengths of stay (P = 0.021). The American Society of Anesthesiologists (ASA) classification significantly predicted increased rates of longer lengths of stay, with ASA class III being more likely than ASA class I (odds ratio [OR]: 4.8; 95% confidence interval [CI]: [1.7-14.2]; P = 0.004) or ASA class II (OR: 3.0; 95% CI [1.2-7.4]; P = 0.016) for patients to remain in hospital for longer than one day. Furthermore, patients who underwent an OLT with ASA class III underwent greater than average lengths of stay than ASA class I patients (0.54 ± 0.9 vs. 0.14 ± 0.5 days, respectively; P = 0.011). Hypertension requiring medication and ASA classification predicted, in a positive manner, postoperative complications occurring in patients with an OLT. Despite being related with extended lengths of stay, only hypertension requiring medication were associated with increased rates of readmission. Orthopaedic surgeons may use these findings to counsel patients on their risk factors and subsequently prepare themselves for peri- and post-operative complications.
Collapse
Affiliation(s)
- Ryan M Kong
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Marina Ibrahim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Dan Monessa
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Faisal Elali
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Zenab Jamil
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Theresa Abdo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Jaime A Uribe
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Nishant Suneja
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Jungmann PM, Lange T, Wenning M, Baumann FA, Bamberg F, Jung M. Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends. Open Access J Sports Med 2023; 14:29-46. [PMID: 37252646 PMCID: PMC10216848 DOI: 10.2147/oajsm.s397634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries. Methods Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle. Results The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16-40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle. Conclusion Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.
Collapse
Affiliation(s)
- Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Markus Wenning
- Department of Orthopedic and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frédéric A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
3
|
Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for lateral osteochondral lesions of the talus: operative technique. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:82-91. [PMID: 36622413 PMCID: PMC10076387 DOI: 10.1007/s00064-022-00789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/10/2021] [Accepted: 11/21/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To provide a natural scaffold, good quality cells, and growth factors to facilitate replacement of the complete osteochondral unit with matching talar curvature for large osteochondral lesions of the lateral talar dome. INDICATIONS Symptomatic primary and non-primary lateral osteochondral lesions of the talus not responding to conservative treatment. The anterior-posterior or medial-lateral diameter should exceed 10 mm on computed tomography (CT) for primary lesions; for secondary lesions, there are no size limitations. CONTRAINDICATIONS Tibiotalar osteoarthritis grade III, malignancy, active infectious ankle joint pathology, and hemophilic or other diffuse arthropathy. SURGICAL TECHNIQUE Anterolateral arthrotomy is performed after which the Anterior TaloFibular Ligament (ATFL) is disinserted from the fibula. Additional exposure is achieved by placing a Hintermann distractor subluxating the talus ventrally. Thereafter, the osteochondral lesion is excised in toto from the talar dome. The recipient site is micro-drilled in order to disrupt subchondral bone vessels. Thereafter, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exactly fitting shape to match the extracted lateral osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the ATFL is re-inserted followed by potential augmentation with an InternalBrace™ (Arthrex, Naples, FL, USA). POSTOPERATIVE MANAGEMENT Non-weightbearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a computed tomography (CT) scan is performed to assess consolidation of the inserted autograft. The patient is referred to a physiotherapist.
Collapse
|
4
|
van Diepen PR, Dahmen J, Altink JN, Stufkens SA, Kerkhoffs GM. Location Distribution of 2,087 Osteochondral Lesions of the Talus. Cartilage 2021; 13:1344S-1353S. [PMID: 32909458 PMCID: PMC8808869 DOI: 10.1177/1947603520954510] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to evaluate the exact location distribution in patients with osteochondral lesions of the talus (OLTs) using a 9-grid scheme. The secondary aim is to match lesion location to lesion size, arthroscopic or open operation, and trauma occurrence. METHODS A systematic review was performed in the databases PubMed, EMBASE, and Cochrane. Search terms consisted of "talus" and "osteochondral lesion." Two independent reviewers evaluated search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome measure was OLT location in the 9 zone-grid. Secondary outcome measures were OLT size in 9-zones, preoperative radiological modality use, demographic lesion size variables as well as open or arthroscopic treatment. RESULTS Fifty-one articles with 2,087 OLTs were included. Heterogeneity concerning methodological nature was observed and methodological quality was low. The posteromedial (28%) and centromedial (31%) zones combined as one location was the location with the highest incidence of OLTs with a rate of 59%. Individual OLT size was reported for only 153 lesions (7%). Preoperative combination of X-ray and magnetic resonance imaging (MRI), and/or computed tomography (CT) was reported in 20 studies (43%). Trauma was reported in 78% of patients. Furthermore, 67% was treated arthroscopically and 76% received primary OLT treatment. CONCLUSION The majority of OLTs are located in the posteromedial and centromedial zone, while the largest OLTs were reported in the centrocentral zone. Further research is required to identify the prognostic impact of location occurrence on the outcomes following OLT treatment.
Collapse
Affiliation(s)
- Pascal R. van Diepen
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - J. Nienke Altink
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands,Gino M.M.J. Kerkhoffs, Department of
Orthopedic Surgery, Academic Medical Center, University of Amsterdam,
Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| |
Collapse
|
5
|
Alshaikh L, Katakura M, Shimozono Y. Comment on "Concomitant ankle instability has a negative impact on the quality of life in patients with osteochondral lesions of the talus: data from the German Cartilage Registry (KnorpelRegister DGOU)". Knee Surg Sports Traumatol Arthrosc 2021; 29:2733-2734. [PMID: 33201270 DOI: 10.1007/s00167-020-06349-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Affiliation(s)
| | - Mai Katakura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiharu Shimozono
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| |
Collapse
|
6
|
Park JH, Park KH, Cho JY, Han SH, Lee JW. Bone Marrow Stimulation for Osteochondral Lesions of the Talus: Are Clinical Outcomes Maintained 10 Years Later? Am J Sports Med 2021; 49:1220-1226. [PMID: 33661712 DOI: 10.1177/0363546521992471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic bone marrow stimulation (BMS) is considered the first-line treatment for osteochondral lesions of the talus (OLTs). However, the long-term stability of the clinical success of BMS remains unclear. PURPOSE To investigate the long-term clinical outcomes among patients who underwent BMS for OLT and to identify prognostic factors for the need for revision surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective analysis was performed on 202 ankles (189 patients) that were treated with BMS for OLT and had a minimum follow-up of 10 years. The visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, and the Foot and Ankle Outcome Score (FAOS) were assessed by repeated measures analysis of variance. Prognostic factors associated with revision surgery were evaluated with Cox proportional hazard regression models and log-rank tests. RESULTS The mean lesion size was 105.32 mm2 (range, 19.75-322.79); 42 ankles (20.8%) had large lesions (≥150 mm2). The mean visual analog scale for pain improved from 7.11 ± 1.73 (mean ± SD) preoperatively to 1.44 ± 1.52, 1.46 ± 1.57, and 1.99 ± 1.67 at 1, 3 to 6, and ≥10 years, respectively, after BMS (P < .001). The mean ankle-hindfoot score also improved, from 58.22 ± 13.57 preoperatively to 86.88 ± 10.61, 86.17 ± 10.23, and 82.76 ± 11.65 at 1, 3 to 6, and ≥10 years after BMS (P < .001). The FAOS at the final follow-up was 82.97 ± 13.95 for pain, 81.81 ± 14.64 for symptoms, 83.49 ± 11.04 for activities of daily living, 79.34 ± 11.61 for sports, and 78.71 ± 12.42 for quality of life. Twelve ankles underwent revision surgery after a mean 53.5 months. Significant prognostic factors associated with revision surgery were the size of the lesion (preoperative magnetic resonance imaging measurement ≥150 mm2; P = .014) and obesity (body mass index ≥25; P = .009). CONCLUSION BMS for OLT yields satisfactory clinical outcomes at a mean follow-up of 13.9 years. The success of the surgery may depend on the lesion size and body mass index of the patient.
Collapse
Affiliation(s)
- Jae Han Park
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jae Yong Cho
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
7
|
Kim YS, Kim TY, Koh YG. Demographic Predictors of Concomitant Osteochondral Lesion of the Talus in Patients With Chronic Lateral Ankle Instability. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211013344. [PMID: 35097450 PMCID: PMC8702748 DOI: 10.1177/24730114211013344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle (P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.
Collapse
Affiliation(s)
- Yong Sang Kim
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Yong Gon Koh
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| |
Collapse
|
8
|
Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects : Operative technique. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 33:160-169. [PMID: 32902691 PMCID: PMC8041673 DOI: 10.1007/s00064-020-00673-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/30/2019] [Accepted: 11/02/2019] [Indexed: 02/06/2023]
Abstract
Objective Provision of a natural scaffold, good quality cells, and growth factors in order to facilitate the replacement of the complete osteochondral unit with matching talar curvature for large medial primary and secondary osteochondral defects of the talus. Indications Symptomatic primary and secondary medial osteochondral defects of the talus not responding to conservative treatment; anterior–posterior or medial–lateral diameter >10 mm on computed tomography (CT); closed distal tibial physis in young patients. Contraindications Tibiotalar osteoarthritis grade III; multiple osteochondral defects on the medial, central, and lateral talar dome; malignancy; active infectious ankle joint pathology. Surgical technique A medial distal tibial osteotomy is performed, after which the osteochondral defect is excised in toto from the talar dome. The recipient site is microdrilled in order to disrupt subchondral bone vessels. Then, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exact fitting shape to match the extracted osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the osteotomy is reduced with two 3.5 mm lag screws and the incision layers are closed. In cases of a large osteotomy, an additional third tubular buttress plate is added, or a third screw at the apex of the osteotomy. Postoperative management Non-weight bearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a CT scan is performed to assess consolidation of the osteotomy and the inserted autograft. The patient is referred to a physiotherapist. Results Ten cases underwent the TOPIC procedure, and at 1 year follow-up all clinical scores improved. Radiological outcomes showed consolidation of all osteotomies and all inserted grafts showed consolidation. Complications included one spina iliaca anterior avulsion and one hypaesthesia of the saphenous nerve; in two patients the fixation screws of the medial malleolar osteotomy were removed.
Collapse
|
9
|
Cao Y, Xu Y, Huang Q, Hong Y, Xu X. Characteristics of Osteochondral Lesions of the Talus in Different Age Groups. Int J Sports Med 2020; 41:873-878. [PMID: 32688411 DOI: 10.1055/a-1186-1575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We analyzed the characteristics of 112 consecutive patients who were operatively treated for osteochondral lesions of the talus from August 2014 to April 2019 in our hospital. The patients were divided into three age groups: young-adult (<40 years), middle-age (40-60 years) and old-age (>60 years). The basic clinical features, localization and size of the lesions, Hepple stage, and surgical procedures were compared among groups. Several significant differences were found on the characteristics of osteochondral lesions of the talus among age groups. There were more female patients in the old-age group (p<0.01), and old patients had a longer duration of symptoms (p<0.05). The OLTs in middle- and old-age patients were mostly located in the medial part of the talus with larger depth (p<0.01). Hepple stage 5, the cystic type, was very common in the old-age group (p<0.01). With regard to surgical procedures, more osteochondral autograft transplantations were applied in the old-age group (p<0.01). Female and deep medial talar subchondral cyst is the typical characteristics of patients over 60 years old. Age is an important factor that must be considered when choosing surgery procedure for patients with osteochondral lesions of the talus.
Collapse
Affiliation(s)
- Yongxing Cao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Huang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Hong
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyang Xu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
10
|
Toale J, Shimozono Y, Mulvin C, Dahmen J, Kerkhoffs GMMJ, Kennedy JG. Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119879127. [PMID: 31696137 PMCID: PMC6822192 DOI: 10.1177/2325967119879127] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Bone marrow stimulation (BMS) is a common surgical intervention in the treatment of small osteochondral lesions of the talus (OLTs). Evidence has shown good clinical outcomes after BMS in the short term, but several studies have shown less favorable results at midterm and long-term follow-up because of fibrocartilaginous repair tissue degeneration. Purpose: To evaluate the clinical and radiological outcomes of BMS in the treatment of primary OLTs at midterm and long-term follow-up and to investigate reported data in these studies. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical and radiological outcomes as well as reported data were evaluated. Results: A total of 15 studies comprising 853 patients (858 ankles) were included at a weighted mean follow-up time of 71.9 months. There were 9 studies that used the American Orthopaedic Foot & Ankle Society (AOFAS) score, with a weighted mean postoperative score of 89.9. There were 3 studies that measured postoperative magnetic resonance imaging results in the midterm using the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system and showed 48% of patients with complete filling, 74% with complete integration, and 76% with surface damage. There was a complication rate of 3.4% and a reoperation rate of 6.0% after BMS in the midterm. Conclusion: This systematic review found good clinical outcomes after BMS at midterm follow-up for primary OLTs. Radiological outcomes showed repair tissue surface damage in the majority of patients, which may be a harbinger for long-term problems. Data were variable, and numerous data were underreported. Further high-quality studies, a validated outcome scoring system, and further radiological reports at midterm follow-up are required to accurately assess the success of BMS in the midterm.
Collapse
Affiliation(s)
- James Toale
- Hospital for Special Surgery, New York, New York, USA.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Conor Mulvin
- Hospital for Special Surgery, New York, New York, USA.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jari Dahmen
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - John G Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| |
Collapse
|
11
|
Hurley ET, Shimozono Y, McGoldrick NP, Myerson CL, Yasui Y, Kennedy JG. High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2019; 27:2721-2730. [PMID: 29582098 DOI: 10.1007/s00167-018-4913-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return to play guidelines and subsequent rates and timing of return to play following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT). METHODS MEDLINE, EMBASE and the Cochrane Library were searched according to the PRISMA guidelines in September 2017. The rate and timing of return to play was assessed. The rehabilitation protocols were recorded, including time to start range of motion, partial weight-bearing and complete weight-bearing. RESULTS Fifty-seven studies with 3072 ankles were included, with a mean age of 36.9 years (range 23-56.8 years), and a mean follow-up of 46.0 months (range 1.5-141 months). The mean rate of return to play was 86.8% (range 60-100%), and the mean time to return to play was 4.5 months (range 3.5-5.9 months). There was large variability in the reported rehabilitation protocols. Range of motion exercises were most often allowed to begin in the first week (46.2%), and second week postoperatively (23.1%). The most commonly reported time to start partial weight-bearing was the first week (38.8%), and the most frequently reported time of commencing full weight-bearing was 6 weeks (28.8%). Surgeons most often allowed return to play at 4 months (37.5%). CONCLUSIONS There is a high rate of return following BMS for OLT with 86.8% and the mean time to return to play was 4.5 months. There is also a significant deficiency in reported rehabilitation protocols, and poor quality reporting in return to play criteria. Early weightbearing and early postoperative range of motion exercises appear to be advantageous in accelerated return to sports. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Eoghan T Hurley
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Charles L Myerson
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - John G Kennedy
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
| |
Collapse
|
12
|
Yasui Y, Hannon CP, Fraser EJ, Ackermann J, Boakye L, Ross KA, Duke GL, Shimozono Y, Kennedy JG. Lesion Size Measured on MRI Does Not Accurately Reflect Arthroscopic Measurement in Talar Osteochondral Lesions. Orthop J Sports Med 2019; 7:2325967118825261. [PMID: 30800691 PMCID: PMC6378450 DOI: 10.1177/2325967118825261] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Lesion size is a major determinant of treatment strategy for osteochondral lesions of the talus (OLTs). Although magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of OLTs, the reliability of the MRI measurement compared with the arthroscopic measurement is unknown. Purpose: To compare preoperative lesion size measured on MRI versus intraoperative lesion size measured during arthroscopy. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively reviewed a consecutive series of patients treated with bone marrow stimulation for OLTs. The diameter of the lesion was measured at its widest point in 2 planes, and MRI measurements were compared with those made during arthroscopy using a custom-made graduated probe. Results: A total of 39 patients with 45 OLTs were analyzed. Mean ± SD area measurements on MRI were significantly greater than the equivalent arthroscopic measurements (42.2 ± 30.5 vs 28.6 ± 23.1 mm2, respectively; P = .03). Compared with the arthroscopic measurement, MRI overestimated OLT size in 53.3% (24/45) of ankles and underestimated OLT size in 24.4% (11/45). The mean MRI diameter measurement was significantly greater than the arthroscopic measurement in the coronal plane (MRI diameter vs arthroscopic measurement coronal plane, 6.1 ± 2.6 vs 4.9 ± 2.3 mm, P = .03; sagittal plane, 8.0 ± 3.6 vs 6.3 ± 3.6 mm, P = .05). Further, MRI overestimated coronal diameter in 48.9% (22/45) of ankles and underestimated in 26.7% (12/45) compared with the arthroscopic measurement. Similarly, sagittal plane MRI diameter measurements overestimated lesion size in 46.7% (21/45) of ankles and underestimated lesion size in 28.9% (13/45) compared with the arthroscopic findings. Conclusion: In a majority of lesions, MRI overestimated OLT area and diameter compared with arthroscopy. Surgeons should be aware of the discrepancies that can exist between MRI and arthroscopic measurements, as these data are important in making treatment decisions and educating patients.
Collapse
Affiliation(s)
- Youichi Yasui
- Hospital for Special Surgery, New York, New York, USA.,Teikyo University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan
| | - Charles P Hannon
- Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Rush University Medical Center (C.P.H.), Chicago, Illinois, USA
| | | | | | | | - Keir A Ross
- Hospital for Special Surgery, New York, New York, USA
| | - Gavin L Duke
- East River Medical Imaging, New York, New York, USA
| | | | | |
Collapse
|
13
|
Yasui Y, Ramponi L, Seow D, Hurley ET, Miyamoto W, Shimozono Y, Kennedy JG. Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies. World J Orthop 2017; 8:956-963. [PMID: 29312855 PMCID: PMC5745439 DOI: 10.5312/wjo.v8.i12.956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/27/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT).
METHODS Two reviewers searched the PubMed/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence (LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score.
RESULTS This review included 22 studies. Overall, 21 of the 22 (95.5%) included studies were level IV or level III evidences. The remaining study was a level II evidence. MQOE analysis revealed 14 of the 22 (63.6%) included studies having fair quality, 7 (31.8%) studies having poor quality and only 1 study having excellent quality.
CONCLUSION The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.
Collapse
Affiliation(s)
- Youichi Yasui
- 2nd Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
- Hospital for Special Surgery, New York, NY 10021, United States
| | - Laura Ramponi
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Rizzoli Orthopaedic Institute, Bologna 4136, Italy
| | - Dexter Seow
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Eoghan T Hurley
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Wataru Miyamoto
- Hospital for Special Surgery, New York, NY 10021, United States
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | | | - John G Kennedy
- Hospital for Special Surgery, New York, NY 10021, United States
| |
Collapse
|
14
|
Candela V, Longo UG, Ciuffreda M, Salvatore G, Berton A, Cimmino M, Denaro V. Talar osteochondral size influences outcome after bone marrow stimulation: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
15
|
Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, Calder JDF, Takao M, Vannini F, Choi WJ, Lee JW, Stone J, Kennedy JG. Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. Am J Sports Med 2017; 45:1698-1705. [PMID: 27852595 DOI: 10.1177/0363546516668292] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. PURPOSE To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. STUDY DESIGN Systematic review. METHODS A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. RESULTS Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. CONCLUSION An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.
Collapse
Affiliation(s)
| | - Youichi Yasui
- Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Christopher D Murawski
- Hospital for Special Surgery, New York, New York, USA.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, Amsterdam, the Netherlands
| | | | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | | | - Woo Jin Choi
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - James Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | |
Collapse
|
16
|
|
17
|
Diagnosis and treatment of osteochondral lesions of the ankle: current concepts. Rev Bras Ortop 2016; 51:489-500. [PMID: 27818968 PMCID: PMC5091026 DOI: 10.1016/j.rboe.2016.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/05/2015] [Indexed: 02/08/2023] Open
Abstract
We conducted a wide-ranging review of the literature regarding osteochondral lesions of the ankle, with the aim of presenting the current concepts, treatment options, trends and future perspectives relating to this topic.
Collapse
|
18
|
Ozal ST, Akca A, Cakmakci E. Is there a relationship between talar osteochondral lesions and foot angles? Radiol Med 2016; 121:801-4. [PMID: 27306999 DOI: 10.1007/s11547-016-0663-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 06/01/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to evaluate the relationship between talar osteochondral defects (OCDs) and foot angles in this study. MATERIALS AND METHODS We performed a retrospective study that included 25 patients with talar OCD and 29 patients without OCD who underwent magnetic resonance imaging in our department between September 2013 and January 2015. We retrospectively measured the foot angles (Bohler's angle, lateral talocalcaneal angle and calcaneal inclination angle) on ankle radiographs in both groups. RESULTS Bohler's angle showed no significant differences between the patients (range 20.50°-48.10°, mean 33.40° ± 6.09°) and the control group (range18.80°-42.40°, mean 31.95° ± 4.21°) (p = 0.397). Calcaneal inclination angle showed no significant differences between the patients (range 3°-29.2°, mean 20.55° ± 6.73°) and the control group (range 10.20°-29.80° mean 20.47° ± 4.21°) (p = 0.956). However, talocalcaneal angle was significantly higher in the patients (range 27.80°-44.80°, median 39.50° ± 6.18°) compared with the control group (range 22.60°-40.50°, median 34.10° ± 4.26°) (p = 0.032). CONCLUSION There is an association between lateral talocalcaneal angle and non-traumatic talar OCD.
Collapse
Affiliation(s)
- Safiye Tokgoz Ozal
- Department of Radiology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Akca
- Department of Radiology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Emin Cakmakci
- Department of Radiology, Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| |
Collapse
|
19
|
Pinski JM, Boakye LA, Murawski CD, Hannon CP, Ross KA, Kennedy JG. Low Level of Evidence and Methodologic Quality of Clinical Outcome Studies on Cartilage Repair of the Ankle. Arthroscopy 2016; 32:214-22.e1. [PMID: 26372522 DOI: 10.1016/j.arthro.2015.06.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the level of evidence and methodologic quality of studies reporting surgical treatments for osteochondral lesions of the ankle. METHODS A search was performed using the PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases for all studies in which the primary objective was to report the outcome after surgical treatment of osteochondral lesions of the ankle. Studies reporting outcomes of microfracture, bone marrow stimulation, autologous osteochondral transplantation, osteochondral allograft transplantation, and autologous chondrocyte implantation were the focus of this analysis because they are most commonly reported in the literature. Two independent investigators scored each study from 0 to 100 based on 10 criteria from the modified Coleman Methodology Score (CMS) and assigned a level of evidence using the criteria established by the Journal of Bone and Joint Surgery. Data were collected on the study type, year of publication, number of surgical procedures, mean follow-up, preoperative and postoperative American Orthopaedic Foot & Ankle Society score, measures used to assess outcome, geography, institution type, and conflict of interest. RESULTS Eighty-three studies reporting the results of 2,382 patients who underwent 2,425 surgical procedures for osteochondral lesions of the ankle met the inclusion criteria. Ninety percent of studies were of Level IV evidence. The mean CMS for all scored studies was 53.6 of 100, and 5 areas were identified as methodologically weak: study size, type of study, description of postoperative rehabilitation, procedure for assessing outcome, and description of the selection process. There was no significant difference between the CMS and the type of surgical technique (P = .1411). A statistically significant patient-weighted correlation was found between the CMS and the level of evidence (r = -0.28, P = .0072). There was no statistically significant patient-weighted correlation found between the CMS and the institution type (r = 0.05, P = .6480) or financial conflict of interest (r = -0.16, P = .1256). CONCLUSIONS Most studies assessing the clinical outcomes of cartilage repair of the ankle are of a low level of evidence and of poor methodologic quality. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
Collapse
Affiliation(s)
- John M Pinski
- Hospital for Special Surgery, New York, New York, U.S.A
| | | | | | | | - Keir A Ross
- Hospital for Special Surgery, New York, New York, U.S.A
| | - John G Kennedy
- Hospital for Special Surgery, New York, New York, U.S.A..
| |
Collapse
|
20
|
Kobayashi T, Suzuki E, Yamazaki N, Suzukawa M, Akaike A, Shimizu K, Gamada K. In Vivo Talocrural Joint Contact Mechanics With Functional Ankle Instability. Foot Ankle Spec 2015; 8:445-53. [PMID: 25956876 DOI: 10.1177/1938640015585967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Functional ankle instability (FAI) may involve abnormal kinematics and contact mechanics during ankle internal rotation. Understanding of these abnormalities is important to prevent secondary problems in patients with FAI. However, there are no in vivo studies that have investigated talocrural joint contact mechanics during weightbearing ankle internal rotation. The objective of this study to determine talocrural contact mechanics during weightbearing ankle internal rotation in patients with FAI. METHODS Twelve male subjects with unilateral FAI (age range, 18-26 years) were enrolled. Computed tomography and fluoroscopic imaging of both lower extremities were obtained during weightbearing passive ankle joint complex rotation. Three-dimensional bone models created from the computed tomographic images were matched to the fluoroscopic images to compute 6 degrees of freedom for talocrural joint kinematics. The closest contact area in the talocrural joint in ankle neutral rotation and maximum internal rotation during either dorsiflexion or plantar flexion was determined using geometric bone models and talocrural joint kinematics data. RESULTS The closest contact area in the talus shifted anteromedially during ankle dorsiflexion-internal rotation, whereas it shifted posteromedially during ankle plantar flexion-internal rotation. The closest contact area in FAI joints was significantly more medial than that in healthy joints during maximum ankle internal rotation and was associated with excessive talocrural internal rotation or inversion. DISCUSSION This study demonstrated abnormal talocrural kinematics and contact mechanics in FAI subjects. Such abnormal kinematics may contribute to abnormal contact mechanics and may increase cartilage stress in FAI joints. LEVEL OF EVIDENCE Therapeutic, Level IV: cross-sectional case-control study.
Collapse
Affiliation(s)
- Takumi Kobayashi
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Eiichi Suzuki
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Naohito Yamazaki
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Makoto Suzukawa
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Atsushi Akaike
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Kuniaki Shimizu
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Kazuyoshi Gamada
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Orthopaedics, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (ES)Department of Medical Radiation, Kanagawa Prefectural Shiomidai Hospital, Kanagawa, Japan (NY)Department of Rehabilitation, Yokohama Sports Medical Center, Kanagawa, Japan (MS)Department of Orthopaedics, Yokohama Sports Medical Center, Kanagawa, Japan (AA, KS)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| |
Collapse
|
21
|
Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture. Knee Surg Sports Traumatol Arthrosc 2015; 23:860-7. [PMID: 24841942 DOI: 10.1007/s00167-014-3061-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 05/02/2014] [Indexed: 01/29/2023]
Abstract
PURPOSE To compare the outcomes of arthroscopic microfracture for chondral and osteochondral lesions of the talus, and to identify the characteristics. METHOD One hundred and four ankles were divided into two groups, namely chondral group (58 ankles) and osteochondral group (46 ankles). The chondral group consisted of 37 men and 21 women with a mean age of 41.5 years [95 % confidence interval (CI) 38.9-44.1] and a mean follow-up duration of 37.6 months (95 % CI 34.7-40.5). The osteochondral group consisted of 25 men and 21 women with a mean age of 22.5 years (95 % CI 19.5-22.5) and a mean follow-up duration of 38.3 months (95 % CI 35.4-41.2). Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and ankle activity score (AAS). RESULTS Mean AOFAS score was 64.9 points (95 % CI 63.0-66.9) in the chondral group and 68.2 points (95 % CI 65.8-70.5) in the osteochondral group preoperatively, and it had improved to 88.8 points (95 % CI 86.8-90.8) and 93.5 points (95 % CI 91.4-95.6) at final follow-up. Mean AAS changed from 2.7 (95 % CI 2.5-2.9) preoperatively to 6.4 (95 % CI 6.0-6.8) in the chondral group, and from 2.5 (95 % CI 2.3-2.8) preoperatively to 6.6 (95 % CI 6.3-6.9) in the osteochondral group at final follow-up. No significant differences were found between the two groups in terms of AOFAS and AAS. The chondral group showed older age, less trauma history, longer symptom duration, smaller lesion size, and more frequent degenerative changes such as subchondral cyst and synovitis. CONCLUSION Both chondral and osteochondral lesions of the talus treated with arthroscopic microfracture showed similar good clinical outcomes. It is important to note that two groups had different characteristics in age distribution, frequency of trauma history, symptom duration, lesion size and location, and incidence of degenerative changes. This study demonstrated that microfracture could improve clinical outcomes significantly both chondral and osteochondral lesions of talus despite their different characteristics.
Collapse
|
22
|
Abstract
Local cartilage or osteochondral degeneration of the ankle are common, painful posttraumatic conditions in young, sport-active patients. Conservative treatment of the acute initial stage of local cartilage or osteochondral damage might be indicated, but commonly fails in the presence of local or asymmetric osteoarthritic disease. Many surgical treatment methods are available for the orthopedic surgeon, which show satisfactory short-term to mid-term results. However, the scientific evidence for these procedures is weak. This article discusses the commonly used methods for cartilage and osteochondral repair and new upcoming methods, plus the role of concomitant disorders of the ankle joint.
Collapse
|
23
|
|